Risk factors for mortality among neonates admitted to a special care unit in a low-resource setting

Abstract

Background Although under-5 mortality has decreased in the last two decades, neonatal mortality remains a global health challenge. Despite achieving notable progress, Ethiopia has still one of the highest neonatal mortality rates worldwide. We aimed to assess the risk factors for mortality among neonates admitted to a special care unit in a referral hospital in rural Ethiopia. Methods This was a retrospective observational study including all 4182 neonates admitted to the special care unit of the St. Luke Wolisso Hospital (Ethiopia) from January 2014 to December 2017. Data were retrieved from hospital charts and entered in an anonymized dataset. A logistic regression model was applied to identify predictors of mortality and effect sizes were expressed as odds ratios with 95% confidence intervals. Results Proportion of deaths was 17% (709/4182 neonates). Neonates referred from other health facilities or home (odds ratio 1.52, 95% confidence interval 1.21 to 1.91), moderate hypothermia at admission (odds ratio 1.53, 95% confidence interval 1.09 to 2.15) and diagnosis of late-onset sepsis (odds ratio 1.63, 95% confidence interval 1.12 to 2.36), low birthweight (odds ratio 2.48, 95% confidence interval 2.00 to 3.09), very low birthweight (odds ratio 11.71, 95% confidence interval 8.63 to 15.94), extremely low birthweight (odds ratio 76.04, 95% confidence interval 28.54 to 263.82), intrapartum-related complications (odds ratio 4.69, 95% confidence interval 3.55 to 6.20), meconium aspiration syndrome (odds ratio 2.34, 95% confidence interval 1.15 to 4.43), respiratory distress (odds ratio 2.25, 95% confidence interval 1.72 to 2.95), other infections (odds ratio 1.92, 95% confidence interval 1.31 to 2.81) or malformations (odds ratio 2.32, 95% confidence interval 1.49 to 3.57) were associated with increased mortality. Being admitted in 2017 vs. 2014 (odds ratio 0.71, 95% confidence interval 0.52 to 0.97), and older age at admission (odds ratio 0.95, 95% confidence interval 0.93 to 0.97) were associated with decreased likelihood of mortality. Conclusions The majority of neonatal deaths was associated with preventable and treatable conditions. Education on neonatal resuscitation and postnatal management, and the introduction of an on-call doctor for high-risk deliveries might have contributed to the reduction in neonatal mortality over time.

Determinants of neonatal mortality among neonates admitted to neonatal intensive care unit of Dessie comprehensive and specialized hospital, Northeast Ethiopia; An unmatched case-control study

“…The odds of neonatal mortality among referred neonates were almost five times higher compared to neonates who were not referred. This finding was similar to the results of a study done in India, a low resource setting, and Ethiopia (43)(44)(45). This might be due to delays in deciding to seek care, delay in reaching a first referral level facility, and delay in actually receiving care after arriving at the facility.…”

Risk factors for mortality in a hospitalised neonatal cohort in Botswana

“…In Ethiopia, a retrospective observational study over a 3-year period showed a death rate of 709 of 4182 (19%) in hospitalised neonates. 18 Here, risk factors for death included infants transported from home/other facilities, an inverse correlation between birth weight and risk of death, and an association between death and congenital malformations. The presence of intrapartum-related complications, likely analogous to HIE, was also a risk factor.…”

“…The presence of intrapartum-related complications, likely analogous to HIE, was also a risk factor. 18 In Uganda, one study demonstrated a mortality rate for all infants in a special care baby unit as 22.1%, with prematurity and its complications accounting for the majority of deaths. 19 However, in Eritrea, a study in a similar NNU revealed a death rate of 66 per 1000 live births despite similar burden of sepsis and comparable population characteristics.…”

Training on the Silverman and Andersen score improved how special care unit nurses assessed neonatal respiratory distress in a low‐resource setting

“…The study was conducted in the special care unit of the St Luke Wolisso Hospital, which is a private referral, non‐profit hospital in the town of Wolisso in the Oromia region of Ethiopia. Around 1.2 million people live in this area, which is served by the Hospital and 80 health facilities 13 . The special care unit comprises one room with 14 beds, with three nurses on the morning, afternoon and night shifts and a paediatrician or medical officer on rotation duty.…”

“…Around 1.2 million people live in this area, which is served by the Hospital and 80 health facilities. 13 The special care unit comprises one room with 14 beds, with three nurses on the morning, afternoon and night shifts and a paediatrician or medical officer on rotation duty. Phototherapy, intravenous therapies and oxygen supplementation are offered, but pulse oximetry is limited.…”